Form FR LL-10(e) FR LL-10(e) Application to Become a Savings and Loan Holding Company

FR LL-10(e)
OMB Number 7100-0336
Approval expires May 31, 2025
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Board of Governors of the Federal Reserve System

Application to Become a Savings and Loan Holding Company
or to Acquire a Savings Association or Savings and Loan
Holding Company—FR LL-10(e)
The application is required by section 10(b)(2) of the Home
Owners' Loan Act (12 U.S.C. § 1467a(b)). This application is to
be filed for certain transactions involving the formation,
acquisition, or merger of a savings and loan holding company
(SLHC); the acquisition by an SLHC of a savings association or

its assets; and the acquisition of control of a savings association
by certain individuals associated with a SLHC. The Federal
Reserve may not conduct or sponsor, and an organization is not
required to respond to, a collection of information unless it
displays a currently valid OMB control number.

Corporate Title of Applicant

Street Address

City

State

Zip Code

(Type of organization, such as corporation, partnership, business trust, association, or trust)

Hereby applies to the Board pursuant to section l0(e) of Home Owners' Loan Act (“HOLA”), 12 U.S.C. 1461 et. seq.; and 12 CFR
238.11(a) through (f),
for prior approval of the acquisition of direct or indirect ownership, control, or power to vote at least
(
%) of a class of voting shares or otherwise to control:
Number
Percent

Hereby is forming a new holding company as part of a reorganization pursuant to section 10(e)(1)(B) of HOLA; and 12 CFR
238.12(a)(2):

Corporate Title of Bank or Bank Holding Company

Street Address

City

State

Zip Code

Does applicant request confidential treatment for any portion of
this submission?

Yes
As required by the General Instructions, a letter justifying
the request for confidential treatment is included.
The information for which confidential treatment is being
sought is separately bound and labeled "Confidential."

No

Public reporting burden for this collection of information is estimated to average 60 hours per response, including the time to gather and maintain data in the required form, to review
instructions and to complete the information collection. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Secretary, Board of Governors of the Federal Reserve System, 20th and C Streets, NW, Washington, DC 20551; and to the Office of Management and Budget,
Paperwork Reduction Project (7100-0336), Washington, DC 20503.

06/2022

FR LL-10(e)
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Name, title, address, telephone number, and facsimile number of person(s) to whom inquiries concerning this application may be directed:
Name

Name

Title

Title

Street Address

Street Address

City

State

Zip Code

City

Area Code / Phone Number

Area Code / Phone Number

Area Code / FAX Number

Area Code / FAX Number

State

Zip Code

Certification
I certify that the information contained in this application has been
examined carefully by me and is true, correct, and complete, and
is current as of the date of this submission to the best of my
knowledge and belief. I acknowledge that any misrepresentation
or omission of a material fact constitutes fraud in the inducement
and may subject me to legal sanctions provided by 18 U.S.C.
§1001 and §1007.
I also certify, with respect to any information pertaining to an individual and submitted to the Board in (or in connection with) this
application, that the applicant has the authority, on behalf of the
individual, to provide such information to the Board and to consent
or to object to public release of such information. I certify that the
applicant and the involved individual consent to public release of
any such information, except to the extent set forth in a written
request by the applicant or the individual, submitted in accordance
with the Instructions to this form and the Board’s Rules Regarding

Signed this

day of
Day

,
Month

Availability of Information (12 C.F.R. Part 261), requesting confidential treatment for the information.
I acknowledge that approval of this application is in the discretion
of the Board of Governors of the Federal Reserve System (the
“Federal Reserve”). Actions or communications, whether oral,
written, or electronic, by the Federal Reserve or its employees in
connection with this filing, including approval if granted, do not
constitute a contract, either express or implied, or any other
obligation binding upon the agency, the United States or any other
entity of the United States, or any officer or employee of the
United States. Such actions or communications will not affect the
ability of the Federal Reserve to exercise its supervisory, regulatory,
or examination powers under applicable laws and regulations. I
further acknowledge that the foregoing may not be waived or
modified by any employee or agency of the Federal Reserve or of
the United States.

.
Year

Signature of Chief Executive Officer or Designee

Print or Type Name

Title

06/2022